目的 通过医教结合试点研究,向教师、家长普及注意缺陷多动障碍(ADHD)相关知识,教授教师、家长行为治疗的基本方法,提高ADHD的知晓度,提高ADHD用药依从性和治疗缓解率。方法 在上海市静安区和普陀区,按照学校大、中、小3种规模进行分层抽样,每一层随机抽取规模相当的2所小学,一所做对照,另一所做干预,即在上述两个区内各抽取6所学校,共12所,对其中一到三年级的全部小学生进行ADHD筛查,共调查小学生5 326名。Conners教师评定量表(TRS)、Conners父母症状问卷(PSQ)初筛阳性,由调查员通过电话方式通知家长带患儿到指定医院复诊,按照《美国精神障碍诊断和统计手册(第五版)》(DSM-5)诊断标准作出诊断。试点区ADHD学生实施学校干预项目,内容包括课堂行为干预,学习技能辅导,同伴互助以及学校家庭定期沟通,每日报告卡制度等;同时开展家庭干预项目,由父母进行观察和督导。使用SNAP-Ⅳ量表进行基线评估和医教结合干预6个月后功能评估。结果 培训前认为ADHD是一种疾病的教师为45.4%, 家长为30.2%;培训后教师为73.1%,家长为59.3%。培训前认为ADHD需要药物治疗的教师为32.6%,家长为20.2%;培训后教师为57.3%,家长为41.5%,差异均有统计学意义(P均<0.01)。用药依从性好者干预组为68.7%,对照组为34.4%;6个月后缓解率干预组为59.6%,对照组为31.1%。影响服药依从性的主要因素依次为家长培训、教师培训人均月收入、医疗费用支付方式。影响治疗缓解率的因素依次为教师培训、家长培训、年龄、就医距离。结论 医教结合干预模式显著提高了家长、教师对ADHD的知晓度,对ADHD药物治疗的依从性和缓解率也有显著提高。

Objective To popularize the knowledge of attention-deficit hyperactivity (ADHD) disorder and teach the basic ways of behavior therapy for teachers and parents by medicine combine with education,and thus to improve the medication adherence and remission rate of ADHD. Methods In Jing'an and Putuo district of Shanghai,a random stratified sampling of 2 primary school in large,medium and small school according to the scale,one as control group,another as intervention group,and a total of 5 326 students from one to three grade were screened with Teacher Rating Scale (TRS) and Parent Symptom Questionnaire (PSQ).The positive were informed by "the investigator through telephone to be taken to the designated hospital by parents.Diagnosis was made according to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition" (DSM-Ⅴ) diagnostic criteria.The Suanson Nolan and Pelham,Version Ⅳ Scale (SNAP-Ⅳ) scale was used for baseline assessment and function assessment after 6 months. Results There were 45.4% teachers and 30.2% parents who thought that ADHD was a disease before training; and there were 73.1% teachers and 59.3% parents after training (P<0.01);There were 32.6% teachers and 20.2% parents who thought that ADHD need medication before training,and there were 57.3% teachers and 41.5% parents after training (P<0.01).There were 68.7% students in intervention group and 34.4% in control with medication for 6 months.After 6 months of intervention,the remission rate was 59.6% in intervention group and 31.1% in control group (P<0.01).The factors influencing the medication adherence were training of parent,training of teacher,the family income,medical treatment charge of payment.The factors influencing remission rate were training of teacher,training of parents,age,distance of medical treatment. Conclusion The modle of medicine combine with education improves the popularity of ADHD for teachers and parents,and meanwhile improves medication adherence and remission rate significantly.